Development and validation of a prognostic nomogram for recurrence-free survival after complete surgical resection of localised primary gastrointestinal stromal tumour: a retrospective analysis

Abstract

Background An optimal staging system to estimate the risk of recurrence following the complete resection of localized, primary gastrointestinal stromal tumor (GIST) has not been established. Recently, it has been shown that adjuvant imatinib mesylate prolongs recurrence-free survival (RFS) following the resection of localized, primary GIST. We sought to develop a nomogram to predict RFS after surgery in the absence of adjuvant therapy to help guide patient selection for adjuvant imatinib therapy. Methods A nomogram to predict RFS based on tumor size (in cm), location (stomach, small intestine, colon/rectum, or other), and mitotic index (<5 or ≥5 mitoses per 50 high power fields) was developed from 127 patients treated at Memorial Sloan-Kettering Cancer Center. The nomogram was tested in cohorts of patients from the Spanish national registry (GEIS; n=212) and the Mayo Clinic (Mayo; n=148). The nomogram was evaluated by calculating concordance probabilities as well as testing calibration of predicted RFS with observed RFS. Concordance probabilities were also compared with those of 3 commonly employed staging systems. Findings The nomogram had a concordance probability of 0.78 (±0.02) in the MSKCC dataset and 0.76 (±0.03) and 0.80 (±0.02) in the validation cohorts. The nomogram predictions were well calibrated. Remodeling the nomogram to include tyrosine kinase mutation status did not improve its discriminatory ability. Concordance probabilities of the nomogram were superior to those of the 2 NIH staging systems (0.76 (±0.03) versus 0.70 (±0.04) (p=0.04) and 0.66 (±0.04) (p=0.01) in the GEIS validation cohort; 0.80 (±0.02) versus 0.74 (±0.02) (p=0.04) and 0.78 (±0.02) (p=0.05) in the Mayo cohort) and equivalent to the AFIP-Miettinen staging system (0.76 (±0.03) versus 0.73 (±0.004) (p=0.28) in the GEIS cohort; 0.80 (±0.02) versus 0.76 (±0.003) (p=0.09) in the Mayo cohort). Nomogram predictions of RFS appeared better calibrated than predictions made using the AFIP-Miettinen system. Interpretation The nomogram accurately predicts RFS following the resection of localized, primary GIST and may be useful to select patients for adjuvant imatinib therapy.

PDL1 expression is an independent prognostic factor in localized GIST

“…4,[10][11][12][13] Several tumor cell-intrinsic molecular prognosticators have been suggested, mainly based on proteins [47][48][49][50][51] or gene signatures 52,53 related to cell proliferation. Potential immune prognostic/predictive parameters have been more recently reported.…”

Gastrointestinal Stromal Tumor of the Stomach Presenting as a Perigastric Abscess

“…15 자발적으로 또는 수술 시에 종괴가 파열될 경우 예후가 좋지 않다. 16 감염과 관련된 임상소견에서 복강 내 농양이 동반된 큰 종괴 가 있을 때 드물지만 GIST와 관련성을 고려할 필요가 있다. 저 자들은 백혈구 수 증가와 발열 등 감염을 시사하는 임상 소견 과 복강 내 농양의 영상학적 소견을 보인 환자에서 수술 후 위 내강과의 누공을 형성한 GIST로 최종 진단된 증례를 보고한다.…”

Gastrointestinal Stromal Tumors

“…GIST rarely metastasize to lymph nodes [67][68][69][70] and therefore regional lymphadenectomy is generally not required. Furthermore, organ-sparing resection (segmental resection, etc.)…”